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New York StateWorkers' Compensation BoardOFFICE OF THE CHAIR328 State Street Schenectady, New York 12305

Governor Andrew M. Cuomo

Subject No. 046-600

Chair Implements Desk Arbitration of Health Care Billing Disputes

Date: August 9, 2013

The Business Relief Act provides for desk arbitration by a single arbitrator to resolve health care billing disputes involving $1,000 or less. In addition, providers may opt for desk arbitration when the amount in dispute exceeds $1,000. The Workers' Compensation Board (Board) has modified its procedures and Form HP-1 to implement these changes.

Desk arbitration involves dispute resolution by a single arbitrator based on paper submission, rather than a hearing before an arbitration panel. The HP-1 with an original signature must be submitted with a check for the arbitration fees. The provider and carrier/self-insured employer each have 30 days from the Board's acknowledgement of the arbitration request to submit any documentation in support of its position. This evidence can be submitted in writing or by referencing a document present in the Board file. After the time for submission has expired, an arbitrator chosen by the Chair will review the evidence and issue a written decision.

Desk arbitration has several advantages. It allows for quicker resolution of disputes and facilitates grouping of disputes involving similar services to be reviewed by an appropriate arbitrator. It also enables the parties to avoid having to appear in person for medical billing disputes that can be readily resolved by paper submission.

To facilitate the new rules, Form HP-1, Health Provider's Request for Decision on Unpaid Medical Bill(s), has been revised. The HP-1 now includes a check box to allow providers to select desk arbitration if more than $1,000 is in dispute. The Board will automatically assign any claim involving $1,000 or less to desk arbitration. New arbitration fees have been established, with reduced fees for desk arbitration. The new fees are as follows:

Amount in Dispute

Desk Arbitration

Panel Arbitration

$0–$1000

$50

–––

$1000.01–$5,000.00

$150

$250

$5,000.01 +

$300

$500

The new form and filing fee schedule take effect on September 1, 2013. All requests for arbitration made on or after September 1, 2013 will require use of the new form which includes a revised fee schedule.

Questions about arbitration of disputed health care bills should be directed to the Medical Director's Office at (800) 781-2362.